Evidence map›Paper›PMID 31101323›Full record

ArticleBritish journal of anaesthesia2019

Preoperative chronic beta-blocker prescription in elderly patients as a risk factor for postoperative mortality stratified by preoperative blood pressure: a cohort study.

Sudhir Venkatesan, Mads Emil Jørgensen, Helen J Manning, Charlotte Andersson, Abdul M Mozid, Mark Coburn, S Ramani Moonesinghe, Pierre Foex, Monty Mythen, Michael P W Grocott and 3 more

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in British journal of anaesthesia, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
2.4field-weighted citation impact, top 10% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 19 citations in OpenAlex.

  1. Revisiting perioperative beta blockade: for what it's worth.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2025
    Article
  2. Article
  3. Hypertension Requiring Medication Use: a Silent Predictor of Poor Outcomes After Pancreaticoduodenectomy.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2023
    Article
  4. Review
  5. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors at 9 institutions in 4 countries.

Sudhir VenkatesanDivision of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK.
Mads Emil JørgensenDepartment of Internal Medicine, Division of Cardiology, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark.
Helen J ManningDepartment of Obstetrics and Gynecology, University of Wisconsin, Madison, WI, USA.
Charlotte AnderssonThe Cardiovascular Research Center, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
Abdul M MozidDepartment of Cardiology, Bristol Heart Institute, Bristol, UK.
Mark CoburnDepartment of Anaesthesia, Medical Faculty, RWTH Aachen University, Aachen, Germany.
S Ramani MoonesingheUniversity College London Hospitals & National Institute of Health Biomedical Research Centre, London, UK.
Pierre FoexNuffield Division of Anaesthetics, Oxford University Hospital, Oxford, UK.
Monty MythenUniversity College London Hospitals & National Institute of Health Biomedical Research Centre, London, UK.
Michael P W GrocottIntegrative Physiology and Critical Illness, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton NIHR Respiratory Biomedical Research Unit, Southampton, UK.
Jonathan G HardmanDepartment of Anaesthesia, University of Nottingham, Nottingham, UK.
Puja R MylesDivision of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK.
Robert D SandersAnesthesiology & Critical Care Trials & Interdisciplinary Outcomes Network, Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. Electronic address: robert.sanders@wisc.edu.
University of Nottingham · GBNational Institute for Health Research · GBUniversity of Wisconsin–Madison · USGentofte Hospital · DKGlostrup Hospital · DKNIHR Bristol Cardiovascular Biomedical Research Unit · GBNuffield Orthopaedic Centre · GBRWTH Aachen University · DEUniversity Hospital Southampton NHS Foundation Trust · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundRecent data suggest that beta blockers are associated with increased perioperative risk in hypertensive patients. We investigated whether beta blockers were associated with an increased risk in elderly patients with raised preoperative arterial blood pressure.

methodsWe conducted a propensity-score-matched cohort study of primary care data from the UK Clinical Practice Research Datalink (2004-13), including 84 633 patients aged 65 yr or over. Conditional logistic regression models, including factors that were significantly associated with the outcome, were constructed for 30-day mortality after elective noncardiac surgery. The effects of beta blockers (primary outcome), renin-angiotensin system (RAS) inhibitors, calcium-channel blockers, thiazides, loop diuretics, and statins were investigated at systolic and diastolic arterial pressure thresholds.

resultsBeta blockers were associated with increased odds of postoperative 30-day mortality in patients with systolic hypertension (defined as systolic BP >140 mm Hg; adjusted odds ratio [aOR]: 1.92; 95% confidence interval [CI]: 1.05-3.51). After excluding patients for whom prior data suggest benefit from perioperative beta blockade (patients with prior myocardial infarction or heart failure), rather than adjusting for them, the point estimate shifted slightly (aOR: 2.06; 95% CI: 1.09-3.89). Compared with no use, statins (aOR: 0.35; 95% CI: 0.17-0.75) and thiazides (aOR: 0.28; 95% CI: 0.10-0.78) were associated with lower mortality in patients with systolic hypertension.

conclusionsThese data suggest that the safety of perioperative beta blockers may be influenced by preoperative blood pressure thresholds. A randomised controlled trial of beta-blocker withdrawal, in select populations, is required to identify a causal relationship.

Indexed as

Adrenergic beta-AntagonistsAgedAged, 80 and overBlood PressureCohort StudiesFemaleHumansHypertensionMalePostoperative ComplicationsPreoperative CareRisk FactorsUnited KingdomAdrenergic beta-Antagonistsbeta blockerblood pressurehypertensionmortalityperioperative outcomerisk factorssurgery

Identifiers

PMID31101323
PMCPMC6676243
OpenAlexW2945145211

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.